Jan. 14, 2001 (not on wire)

FIGHTING FOR THE RIGHT NOT TO TAKE UNNECESSARY MEDICINES

Do you have to take antibiotics when you go to the dentist to have your teeth cleaned?

Well, neither do I -- now -- but it was a struggle.

When I moved to Denver in the spring of 1997, I chose a dentist based on a colleague's recommendation. Did all the usual stuff, filled out all the forms, including a medical history, and the morning I turned up for my first appointment the dental hygienist asked, ''Did you take your premeds?''

''What?''

''Premeds,'' she said. ''Antibiotics.

''It says here you had rheumatic fever,'' she added by way of explanation.

So I did, in 1949 or so, but I had no heart damage -- I didn't even get excused from gym when I went back to school -- and that's been good enough for a half-century's worth of dentists.

But she was adamant. No medicine, no dental work.

''It's the law,'' she said.

I knew that was untrue. And I hate it, I absolutely hate it, when people make up stuff to get me to go along with whatever suits their convenience.

She knew it was untrue, too, because when I objected she abandoned that tack and said it was the American Dental Association's policy.

That could be true, though it's strange that no one had ever mentioned it to me before.

So I got a prescription, and I took the stupid pills, and I've been fuming about it ever since. Not all the time, you understand, just every time I had to go get my teeth cleaned.

Just last month it occurred to me that this was not merely an irritation; it was a column. That's often the case, though usually I don't need three years to figure it out.

That woman doesn't work there any more, so I asked the new hygienist why they had this requirement. She showed me a 4 x 6 index card, hand-written, listing ''conditions needing pre-med.'' Not exactly authoritative.

And you know what? Rheumatic fever wasn't even on it!

While I was paying my bill, she found another document, from the American Heart Association, which was even more explicit: Rheumatic heart disease, prophylaxis recommended; Previous rheumatic fever without valve dysfunction, prophylaxis not recommended.

Vindication.

But I still had to bring in a note from my doctor, who thought the whole thing very funny.

Of course dentists are worried that they'll be sued if a patient comes in to have her teeth cleaned and ends up dead. And it can happen; the purpose of the antibiotics is to prevent bacterial endocarditis, an infection of the heart muscle that can be fatal. But the risk is negligible for the general population.

Anyway, I already explained to my son Peter that if that happens to me he is not to sue.

''I wouldn't,'' he said. ''A lot of people don't realize that when something goes dreadfully wrong it doesn't mean someone's to blame.''

I checked with the American Heart Association for their latest recommendations, which were published in the Journal of the American Medical Association in June 1997, and subsequently elsewhere. The guidelines clarify what heart conditions put patients at high or moderate risk of endocarditis, for whom antibiotics are recommended, and also for which dental procedures premeds are appropriate. They're on the Web site too, at americanheart.org.

Perhaps you think this is much ado about nothing more than the cost of unnecessary prescriptions. The cost is not insignificant, actually, but the real problem with stuffing people full of antibiotics they don't need is that bacteria evolve resistance. When people do need an antibiotic there may not be any that works against the infection they have.

If you've been dutifully swallowing pills before you go to the dentist find out why you're being told to do that, and make sure the dentist has the most up-to-date information.

Not an index card scribbled years ago.

(654 words)